Recently, I had a patient who died suddenly and unexpectedly after I had seen the patient in the morning for some muscle aches. I reviewed the case to see if there was anything I could have done to prevent it. Did I miss a lab result? Was there some sign that should have been picked up? Were appropriate protocols and guidelines performed? I was convinced I'd find something, some piece of evidence that would've shown that if I had paid more attention, this person would still be alive. It was preventable and avoidable... wasn't it?
One of the strange things about being a doctor is that, despite all the rhetoric about malpractice and liability, it's hard not to feel guilty when bad things happen. You can't walk away without a little blame. This happened on my watch. We go into medicine to help people, so when shit happens, it's hard not to feel responsible. This person trusted me to protect them from a bad outcome, but it happened, and I didn't even see it coming.
A lawyer friend of mine tells me that physicians are terrible in court because we want to take blame. But shouldn't it be my fault? Shouldn't someone be held accountable? And if I'm the patient's doctor, shouldn't it be me?
It took me a long time to figure out that one of my favorite aspects of adult medicine is that so much of it is lifestyle dependent. When something bad happens, I can go home at night and think to myself it may have been something I did, but it may also have been the patient's bacon cheeseburger lunches for 35 years. There is some amnesty in adult care.
If you are disturbed by the thought that your actions (or lack thereof) could hurt someone, or even kill them, then welcome to humanity. But in medicine, even when you are blameless, you may still find some guilt in your heart. And that is medicine. If it happened on my watch, shouldn't it be my fault?